Leak Adjustment Request Form

Required fields indicated by "*"

Service Address*:

Property Owner Name*:

Person Requesting Adjustment*:

Mailing Address*:

Telephone*:

Email*:

Billing Period of Requested Adjustment*:

When Was Leak Discovered?*

Details of Location of Leak*:

When Was Leak Repaired?*

****PLEASE INCLUDE COPIES OF ANY REPAIR BILLS THAT YOU HAVE
AND ANY ADDITIONAL INFORMATION REGARDING LEAK****


Allowed file types: pdf, jpg, jpeg, png, gif, doc, docx
Max file size: 2MB

If unable to scan and upload documents, check this box to acknowledge that you will hand deliver or mail paper copies of required documentation.
I will provide paper copies.

Once we receive this request, it will be reviewed and you will receive notification of any available adjustment. Once you have authorized the adjustment, the credit to your account will be processed.

Please contact the office if you have any questions (425) 355-3355.